Provider Demographics
NPI:1497207658
Name:BODY RESORT, LLC
Entity Type:Organization
Organization Name:BODY RESORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCEL
Authorized Official - Middle Name:SHERRIE
Authorized Official - Last Name:HAMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:D,C
Authorized Official - Phone:404-579-3127
Mailing Address - Street 1:1616 LAWRENCE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-2068
Mailing Address - Country:US
Mailing Address - Phone:404-579-3127
Mailing Address - Fax:
Practice Address - Street 1:1616 LAWRENCE AVE STE B
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-2068
Practice Address - Country:US
Practice Address - Phone:404-579-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty